Subtitles and Transcript

Ivan Oransky

0:11
Those of you who have seen the film "Moneyball,"or have read the book by Michael Lewis,will be familiar with the story of Billy Beane.Billy was supposed to be a tremendous ballplayer; all the scouts told him so.They told his parents thatthey predicted that he was going to be a star.

0:28
But what actually happened when he signed the contract -- and by the way, he didn'twant to sign that contract, he wanted to go to
college --which is what my mother, who actually does
love me,said that I should do too, and I did --well, he didn't do very well. He struggled
mightily.He got traded a couple of times, he ended up in the Minors for most of his career,and he actually ended up in management. He ended up as a General Manager of theOakland A's.

0:53
Now for many of you in this room, ending up in management, which is also what I've done,is seen as a success.I can assure you that for a kid trying to make it in the Bigs,going into management ain't no success story. It's a failure.

1:07
And what I want to talk to you about today, and share with you, is that ourhealthcare system, our medical system, is
just as bad at predictingwhat happens to people in it -- patients,
others --as those scouts were at predicting what would happen to Billy Beane.And yet, every daythousands of people in this countryare diagnosed with preconditions.

1:33
We hear about pre-hypertension, we hear about pre-dementia,we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself withthat in the green room.

1:44
We also refer to subclinical conditions.There's subclinical atherosclerosis, subclinical hardening of the arteries,obviously linked to heart attacks, potentially.One of my favorites is called
subclinical acne.If you look up subclinical acne, you may find a website, which I did,which says that this is the easiest type of acne to treat.You don't have the pustules or the redness and inflammation.Maybe that's because you don't actually
have acne.

2:18
I have a name for all of these conditions, it's another precondition:I call them preposterous.In baseball, the game follows the pre-game.Season follows the pre-season.But with a lot of these conditions, that actually isn't the case, or at least it isn't thecase all the time. It's as if there's a rain delay, every single time in many cases.

2:44
We have pre-cancerous lesions,which often don't turn into cancer.And yet,if you take, for example, subclinical
osteoporosis, a bone thinning disease,the precondition,otherwise known as osteopenia,you would have to treat 270
women for three yearsin order to prevent one broken bone.That's an awful lot of womenwhen you multiply by the number of women
who were diagnosedwith this osteopenia.

3:12
And so is it any wonder,given all of the costs and the side effectsof the drugs that we're using to treat these preconditions, that every yearwe're spending more than two trillion dollars on healthcare and yet100,000 people a year -- and that's a conservative estimate -- are dyingnot because of the conditions they have,but because of the treatments that we're giving them and the complications of those treatments?

3:34
We've medicalized everythingin this country.Women in the audience, I have
somepretty bad news that you already know,and that's that every aspect of your
life

3:46
has been medicalized.Strike one is when you hit puberty.You now have something that happens to you once a month that has been medicalized.It's a condition;it has to be treated. Strike twois if you get pregnant.That's been medicalized as
well.You have to have a high-tech experienceof pregnancy, otherwise something might go wrong.

4:05
Strike three is menopause.We all know what happened when millions of women were given hormone replacement therapyfor menopausal symptomsfor decades until all of a sudden we realized, because a study came out, a big one,NIH-funded.It said,actually, a lot of that hormone replacement therapy may be doing more harm than goodfor many of those women.

4:29
Just in case,I don't want to leave the men out --I am one, after all --I have really bad news for all of you in
this room,and for everyonelistening and watching elsewhere:You all havea universally fatal condition.So, just take a moment.It's called pre-death.Every single one of you has it, because
you have the risk factor for it,which is being alive.

4:56
But I have some good news for you,
becauseI'm a journalist, I like to end things in a happy way or a forward-thinking way.And that good news is that if you can survive to the end of my talk, whichwe'll see if that happens for everyone,you will be a pre-vivor.

5:13
I made up pre-death.If I used someone else's pre-death, I apologize,I think I made it up.I didn't make up pre-vivor.Pre-vivor is what a particular cancer advocacy group would like everyone whojust has a risk factor,but hasn't actually had that cancer,to call themselves.You are a pre-vivor.

5:37
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in theaudience, I'd like to suggesta reality TV show called "Pre-vivor."If you develop a disease, you're off
the island.

5:51
But the problem is, we have a systemthat is completely --basically promoted this.We've selected, at every point in this system,to do what we do, and to give everyone a
precondition and then eventuallya condition, in some cases.Start with the doctor-patient
relationship. Doctors, most of them,are in a fee-for-service system. They are
basically incentivized to do more --procedures, tests,prescribe medications.

6:21
Patients come to them,they want to do something. We're
Americans, we can't just standthere, we have to do something. And so
they want a drug.They want a treatment. They want to be told, this is what you have and this is howyou treat it. If the doctor
doesn't give you that,you go somewhere else.That's not very good for doctors'
business.Or even worse,if you are diagnosed with something
eventually, and the doctor didn't order that test,you get sued.

6:47
We have pharmaceutical companies that are
constantly trying to expandthe indications, expand the number of people who are eligible for a given treatment,because that obviously helps their bottom line.
We have advocacy groups,like the one that's come up with
pre-vivor,who want to make more and more people feel they are at risk, or might have a condition,so that they can raise more fundsand raise visibility, et cetera.

7:10
But this isn't actually,despite what journalists typically do,
this isn't actually about blamingparticular players.We are all responsible.I'm responsible.I actually root for the Yankees, I mean talk
aboutrooting for the worst
possibleoffender when it comes to doing
everything you can do.Thank you.But everyone is responsible.

7:33
I went to medical school,and I didn't have a course called How to Think Skeptically,or How Not to Order Tests.We have this systemwhere that's what you do.And it actually took being a journalistto understand all these incentives. You know, economists like to say,there are no bad people,there are just bad incentives.

7:57
And that's actually true.Because what we've created is a sort of Field of Dreams, when it comes to medical technology.So when you put another MRI in
every corner, you put a robotin every hospital saying that everyone has to have robotic surgery.Well, we've created a system where if you
build it, they will come.But you can actually perverselytell people to come, convince themthat they have to come.

8:23
It was when I became a journalist that I really realized how I was part of this problem,and how we all are part of this problem.I was medicalizing every risk factor, I was writing stories, commissioning stories,every day, that were trying to,not necessarily make people worried, although that was what often happened.

8:40
But, you know, there are ways out.I saw my own internist last week,and he said to me,"You know," and he told me something thateveryone in this audience could have
told me for free,but I paid him for the privilege, which
is thatI need to lose some weight.Well, he's right. I've had honest-to-goodness high blood pressurefor a dozen years now, sameage my father got it,and it's a real disease. It's not pre-hypertension, it's actualhypertension, high blood pressure.

9:10
Well, he's right,but he didn't say to me,well, you have pre-obesity oryou have pre-diabetes, or anything like that. He didn't say,better start taking this Statin, you need to lower your cholesterol.No, he said, "Go out and lose some weight. Come back and see me in a bit,or just give me a call and let me know how you're doing."

9:28
So that's, to me,a way forward.Billy Beane, by the way, learned the same
thing.He learned,from watching this kid who he eventually hired, who was really successful for him,that it wasn't swinging for the fences, it
wasn't swinging at every pitchlike the sluggers do, which is what all the expensive teams like the Yankees like to --they like to pick up those guys.This kid told him, you know, you gotta watch the guys, and you gotta go out and findthe guys who like to walk,because getting on base by a walkis just as good, and in our healthcare
systemwe need to figure out,is that really a good pitchor should we let it go by and not swing at everything?Thanks.